Post on 19-Dec-2015
State Variation in Prevalence of Children Living in
Households with Tobacco Smokers
Kathleen Newton, BS, Oregon MPH Program & Child & Adolescent Health Measurement Initiative (CAHMI)
Dongsoek Choi, PhD, Associate Professor, BiostatisticsOHSU Public Health and Preventive Medicine
Environmental Exposure to Second Hand Tobacco Smoke
Secondhand smoke contains at least 250 chemicals known to be toxic, including more than 50 that can cause cancer
Most exposure to tobacco smoke occurs in homes and workplaces
About 25% of children aged 3–11 years live with at least one smoker, compared to only about 7% of nonsmoking adults
Sudden Infant Death Syndrome (SIDS) Acute respiratory infections Slow lung growth Ear infections and middle ear effusion Increased frequency and severity of
asthma attacks Increased cancer risk
Passive Smoking Health Risks to Children
Explore state-level associations between the extent to which children might be exposed to second hand smoke in their homes and selected health issues among children ages 0 - 17 in the U.S.
Study Objective
2003 National Survey of Children’s Health Stratified random sample of 102,353 children CATI telephone interview with primary
caregiver Weighted to represent the non-institutionalized
population of children ages 0 -17 in each state Questions about a range of topics pertaining to
children’s health, families and communities
Methods
“Does anyone in the household use cigarettes, cigars, or pipe tobacco?”
19 NSCH child health indicators and questions
Methods
Ecological study design State-level weighted prevalence
estimates SPSS Complex Samples ESRI ArcMAP GIS software
Analysis
Significant at α=.05 but very weak (R2<.20) Asthma-related health issues (0–17) Frequent or severe headaches (3–17) Risk of developmental delay (0–5)
Correlations
Correlations
Highly significant but still not strong (R2<.40) Elevated use or need of services (0-17) At risk for developmental delay (0-5) Repeated a grade in school (6-17) Problem behaviors (6-17) Above normal BMI (10-17)
Correlations
Highly significant, moderate correlation (R2>.40) Use/need prescription medication (0-17) Frequent ear infections (3-17) Attention Deficit/Hyperactivity (2-17) Special Health Care Needs (0-17)
Significant association with % exposed to 2nd hand smoke
Prescription Medications
Linear Regression
20.00 30.00 40.00
% Children living in household with smoker (ages 0-17)
10.00
12.00
14.00
16.00
18.00
% CSHCN rxmeds = 6.22 + 0.24 * ind6_4PR-Square = 0.49
Ear Infections
Linear Regression
20.00 30.00 40.00
% Living in household with smoker (ages 0-17)
3.00
4.00
5.00
6.00
7.00
% F
req
uen
t ea
r in
fect
ion
s (a
ges
3-1
7)
% 3 or more ear infections in past 12 months (ages 3-17) = 0.39 + 0.14 * ind6_4PR-Square = 0.48
ADD/ADHDLinear Regression
20.00 30.00 40.00
% Living in household with smoker (ages 0-17)
5.00
6.00
7.00
8.00
9.00
10.00
% A
DD
/AD
HD
(ag
es 2
-17)
% Ever been told child has ADD/ADHD (ages 2-17) = 2.19 + 0.16 * ind6_4PR-Square = 0.45
CSHCN
Linear Regression
20.00 30.00 40.00
% Living in household with smoker (ages 0-17)
14.00
16.00
18.00
20.00
22.00
% C
SH
CN
all
% CSHCN all = 10.43 + 0.24 * ind6_4PR-Square = 0.41
Ecological level analysis supports clinical studies connecting exposure to second hand smoke with a wide range of health problems among children in the U.S.
Presence of a smoker in the household is positively associated with prevalence of Special Health Care Needs among children
Regional clustering of state level prevalence of household smoke exposure can be identified
Conclusions
Effective smoking cessation programs targeting parents will have a positive impact on related child health outcomes
Attention to geographical clustering of high-exposure states could enhance the impact of public health resources.
Public Health Implications
Second Hand SmokeCDC Fact Sheet
cdc.gov/tobacco/data_statistics/Factsheets/SecondhandSmoke.htm#
National Cancer Institute
www.cancer.gov/cancertopics/factsheet/Tobacco/ETS
AAP www.aap.org/healthtopics/tobacco.cfm
National Survey of Children’s Healthwww.nschdata.org www.cahmi.org www.cdc.gov/nchs/about/major/slaits/nsch.htm
Further information…